Made in Germany: A Quality Indicator Not Only in the Automobile Industry But Also When It Comes to Skin Replacement: How an Automobile Textile Research Institute Developed a New Skin Substitute

Abstract

Successful research and development cooperation between a textile research institute, the German Federal Ministry of Education and Research via the Center for Biomaterials and Organ Substitutes, the University of Tübingen, and the Burn Center of Marienhospital, Stuttgart, Germany, led to the development of a fully synthetic resorbable temporary epidermal skin substitute for the treatment of burns, burn-like syndromes, donor areas, and chronic wounds. This article describes the demands of the product and the steps that were taken to meet these requirements. The material choice was based on the degradation and full resorption of polylactides to lactic acid and its salts. The structure and morphology of the physical, biological, and degradation properties were selected to increase the angiogenetic abilities, fibroblasts, and extracellular matrix generation. Water vapor permeability and plasticity were adapted for clinical use. The available scientific literature was screened for the use of this product. A clinical application demonstrated pain relief paired with a reduced workload, fast wound healing with a low infection rate, and good cosmetic results. A better understanding of the product’s degradation process explained the reduction in systemic oxidative stress shown in clinical investigations compared to other dressings, positively affecting wound healing time and reducing the total area requiring skin grafts. Today, the product is in clinical use in 37 countries. This article describes its development, the indications for product growth over time, and the scientific foundation of treatments.

Use of polylactid acid membrane improves outcome of split-thickness skin graft donor sites: a prospective, comparative, randomized study

“…21 In accordance with the presented findings, previous studies have demonstrated a reduction of bleeding following polylactic acid membrane defect coverage. 11,22 However, epithelialization was achieved comparably between groups. According to the literature, epithelialization of donor sites requires 7 to 21 days.…”

The successful use of polylactide wound dressings for chronic lower leg wounds: A retrospective analysis

“…The polylactide wound dressing Suprathel was initially designed to treat burn wounds. 7 Consequently, several studies have investigated its effectiveness on burn wounds of different degrees with promising results. 17 , 18 Its use as an epidermal skin substitute with no need for frequent dressing changes makes it an effective wound dressing for split‐thickness skin donor sites.…”

“… 22 , 24 With advanced wound healing, a wound's pH decreases towards more acidic, and the typical pH values of the surface of healed skin of 4 to 6. 13 , 25 , 26 , 27 This release of lactate anions, which is the working principle of Suprathel, 7 might cause a marked reduction of bacterial load. 28 Furthermore, the postulated increase of lactate as energy provider for wound healing and inductor of cytokines ultimately catalyses the resumption of the wound healing cascade.…”

“…The polylactide wound dressing Suprathel was initially designed to treat burn wounds 7 . Consequently, several studies have investigated its effectiveness on burn wounds of different degrees with promising results 17,18 .…”

“…Suprathel is a porous synthetic copolymer of DL‐lactide. The polylactide degrades to lactic acids and its salts 7 , 8 after using up physiological buffers, ultimately resulting in a signalling of hypoxic conditions in normoxic surroundings, whereby cytokines and growth factors are released influencing the wound healing cascade. 9 , 10 , 11 Given the fact that complicated and chronic wounds often show an increased pH being the foundation for infections and other complications, 12 , 13 the upregulated lactate levels, 14 which are further supported by Suprathel, provide metabolisms to support healing, suggesting Suprathel as potent dressing for the treatment of chronic wounds.…”